Provider Demographics
NPI:1356409643
Name:BUTLER OPTICAL CENTER,INC
Entity type:Organization
Organization Name:BUTLER OPTICAL CENTER,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:CORNETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-459-2460
Mailing Address - Street 1:130 NORTH MULBERRY
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:AL
Mailing Address - Zip Code:36904-2224
Mailing Address - Country:US
Mailing Address - Phone:205-459-2460
Mailing Address - Fax:205-453-2462
Practice Address - Street 1:130 NORTH MULBERRY
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:AL
Practice Address - Zip Code:36904-2224
Practice Address - Country:US
Practice Address - Phone:205-459-2460
Practice Address - Fax:205-453-2462
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009904280Medicaid
AL1236030001Medicare ID - Type Unspecified
AL=========Medicare UPIN